evaluating prison-based therapeutic community substance abuse programs: the california initiative...
TRANSCRIPT
Evaluating Prison-Based Therapeutic Community Substance Abuse
Programs: The California Initiative
William M. Burdon, Ph.D.David Farabee, Ph.D.
Michael L. Prendergast, Ph.D.Nena P. Messina, Ph.D.
Jerome Cartier, M.A.
University of California, Los AngelesIntegrated Substance Abuse Programs
Presented at the World Federation of Therapeutic CommunitiesMelbourne, Australia, February 17-21, 2002
California’s Prison Population
Total = 161,497 (as of 9/30/01)
0
40000
80000
120000
160000
Males Females96% 4%
0
40000
80000
120000
160000
Felons CAs99% 1%
If California was a Country
It would rank 8th among nations in prison population.
It would rank 5th among nations in incarceration rate per 100,000 population.
Sources: Bureau of Justice Statistics International Centre for Prison Studies
PrisonCountry/State PopulationChina 1,427,407 Russian Federation 973,600 India 381,147 Ukraine 219,955 Thailand 206,011 Brazil 194,074 South Africa 166,334 California 161,497
Rate perCountry/State 100,000Russian Federation 671Belarus 554Kazakhstan 522Turkmenistan 489California 474
The California Initiative
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
10000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
32 SAPs7,654 beds
3 SAPs536 beds
SATF
1K & 2K
RJD
38 SAPs (est)9,126 beds
Growth of Prison-Based TC Beds
Prison-based TCs Bedsas a Percent of Estimated Population
in Need of Treatment
5.8%
0%
20%
40%
60%
80%
100%
Male Felons Male CAs FemalesFelons
Female CAs Total
Note: Population in need was estimated to be equivalent to 66% of inmates scheduled to be released within 18 months.
Prison-based TCs Bedsby Gender and Security Level
0
500
1000
1500
2000
2500
Level Imales
Level IImales
Level IIImales
Level IVmales
Male CAs Femalefelons
FemaleCAs
Total = 32 SAPs; 7,654 beds
Description of Treatment Model
6 to 24 months of mandatory prison-based treatment at end of commitment.
Up to 6 months of voluntary community-based treatment following release to parole.
Only partially segregated TC programs.
Broad coverage (security level, gender, felon/CA).
4 hours of treatment activities per day (e.g., individual sessions, group therapy) with program staff (20 hours/week).
Hierarchically structured into three phases: orientation, primary treatment, and pre-release transitioning
Substance Abuse Service Coordination Agencies (SASCAs) function as transitional and case managers for parolees choosing to enter aftercare.
SASCA1
SASCA2
SASCA3
SASCA4
TC2 TCnTC3 TC4 TC5TC1
Reg 1 Providers Reg 2 Providers Reg 3 Providers Reg 4 Providers
The TC/SASCA System
Identifying SAP Participants
A history of substance abuse--including alcohol.
6-24 months left to serve.
Exclusionary criteria:
Placed in a Security Housing Unit within the preceding 12 months for violent behavior (assault and/or battery).
Housed in a Protective Housing Unit within the preceding 12 months.
Certified members or associates of a prison gang. Felony holds that could result in an increase in sentence length. Active Immigration and Naturalization Service holds. Enrolled in Inpatient or Enhanced Outpatient Program (mental
health) services.
UCLA ISAPEvaluation Studies
SATF (1997-2002) 2 TC SAPs, 1 Institution, 739 beds each. Level II males felons.
1,000-Bed Expansion (1998-2003) 5 TC SAPs, 5 Institutions, 200 beds each. 1 TC SAP expanded, 240 beds. Level I-IV male and female felons and male Civil Addicts.
2,000-Bed Expansion (1999-2004) 9 SAPs, 6 Institutions, 100-263 beds each. Level I male felons, Male and female Civil Addicts.
Evaluation Coverageby Gender and Security Level
0
500
1000
1500
2000
2500
Level Imales
Level IImales
Level IIImales
Level IVmales
Male CAs Femalefelons
FemaleCAs
Total = 32 SAPs; 7,654 beds Evaluation coverage: 17 SAPs; 4,939 beds (65%)
Process Evaluation
Covers all 17 TC SAPs
Goals and objectives
Planning and implementation
Organizational structure
SASCA’s and Community-based Treatment Programs
Impact Evaluation
Client characteristics
Client needs
Services received
Client flows
Aftercare participation
Client performance
Outcome Evaluation
Outcomes Recidivism. Drug use. Psychosocial variables.
Records-Based Evaluation Recidivism (OBIS). Relationship between time in program and outcomes. Effect of participation in community-based treatment. Impact of treatment by background status.
Outcome Evaluation
Interview-based Evaluation Treatment-comparison group design. Baseline interview. Pre-release interview. 12-month post-release follow-up interview. Voluntary urine specimen at follow-up.
Economic Cost-Benefit Analysis
Process Evaluation Results
Client Characteristics (SATF, 1K, and 2K)
Implementation and Operational Issues
SATF Program-Level Statistics
1K and 2K 12-Month RTC Data
Client Characteristics
SATF, 1K, and 2K Expansion Programs
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Age 36.7 35.7 35.0 34.2 31.0 31.4 35.3 36.1
Education 11.4 11.6 11.4 11.4 11.1 10.9 11.0 10.9
Ethnic Breakdown
White 34.4% 50.8% 40.1% 32.6% 37.8% 17.4% 44.6% 35.4%
Black 37.7% 26.3% 28.8% 41.8% 29.2% 50.8% 22.4% 32.7%
Hispanic/Mexican 23.3% 17.8% 24.0% 19.2% 27.8% 26.9% 21.4% 20.9%
Other 4.6% 5.1% 7.1% 6.4% 5.2% 4.9% 11.6% 11.0%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Marital Status
Never married 48.0% 42.2% 45.5% 48.6% 56.8% 62.1% 37.8% 42.6%
Married 24.9% 28.9% 24.4% 28.1% 25.6% 19.3% 24.4% 24.2%
Previously married 27.1% 28.9% 30.1% 23.3% 17.6% 18.6% 37.8% 33.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Age 36.7 35.7 35.0 34.2 31.0 31.4 35.3 36.1
Education 11.4 11.6 11.4 11.4 11.1 10.9 11.0 10.9
Ethnic Breakdown
White 34.4% 50.8% 40.1% 32.6% 37.8% 17.4% 44.6% 35.4%
Black 37.7% 26.3% 28.8% 41.8% 29.2% 50.8% 22.4% 32.7%
Hispanic/Mexican 23.3% 17.8% 24.0% 19.2% 27.8% 26.9% 21.4% 20.9%
Other 4.6% 5.1% 7.1% 6.4% 5.2% 4.9% 11.6% 11.0%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Marital Status
Never married 48.0% 42.2% 45.5% 48.6% 56.8% 62.1% 37.8% 42.6%
Married 24.9% 28.9% 24.4% 28.1% 25.6% 19.3% 24.4% 24.2%
Previously married 27.1% 28.9% 30.1% 23.3% 17.6% 18.6% 37.8% 33.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Age 36.7 35.7 35.0 34.2 31.0 31.4 35.3 36.1
Education 11.4 11.6 11.4 11.4 11.1 10.9 11.0 10.9
Ethnic Breakdown
White 34.4% 50.8% 40.1% 32.6% 37.8% 17.4% 44.6% 35.4%
Black 37.7% 26.3% 28.8% 41.8% 29.2% 50.8% 22.4% 32.7%
Hispanic/Mexican 23.3% 17.8% 24.0% 19.2% 27.8% 26.9% 21.4% 20.9%
Other 4.6% 5.1% 7.1% 6.4% 5.2% 4.9% 11.6% 11.0%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Marital Status
Never married 48.0% 42.2% 45.5% 48.6% 56.8% 62.1% 37.8% 42.6%
Married 24.9% 28.9% 24.4% 28.1% 25.6% 19.3% 24.4% 24.2%
Previously married 27.1% 28.9% 30.1% 23.3% 17.6% 18.6% 37.8% 33.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Age 36.7 35.7 35.0 34.2 31.0 31.4 35.3 36.1
Education 11.4 11.6 11.4 11.4 11.1 10.9 11.0 10.9
Ethnic Breakdown
White 34.4% 50.8% 40.1% 32.6% 37.8% 17.4% 44.6% 35.4%
Black 37.7% 26.3% 28.8% 41.8% 29.2% 50.8% 22.4% 32.7%
Hispanic/Mexican 23.3% 17.8% 24.0% 19.2% 27.8% 26.9% 21.4% 20.9%
Other 4.6% 5.1% 7.1% 6.4% 5.2% 4.9% 11.6% 11.0%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
Marital Status
Never married 48.0% 42.2% 45.5% 48.6% 56.8% 62.1% 37.8% 42.6%
Married 24.9% 28.9% 24.4% 28.1% 25.6% 19.3% 24.4% 24.2%
Previously married 27.1% 28.9% 30.1% 23.3% 17.6% 18.6% 37.8% 33.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Alc/Drug Problem
Yes 75% 95% 89% 86% 86% 70% 96% 93%
No 25% 5% 11% 14% 15% 30% 5% 7%
100% 100% 100% 100% 100% 100% 100% 100%
1st serious drug Meth Meth Meth Meth Meth Heroin Meth Coc/Crack
2nd serious drug Alcohol Marijuana Alcohol Alcohol Alcohol Her/Barb Alcohol Alcohol
3rd serious drug Alcohol Alcohol Marijuana Alcohol Alcohol Her/Inhal Alcohol Alcohol
Most recent offense
Property 22.0% 18.9% 24.2% 21.2% 28.7% 26.0% 19.6% 18.1%
Against persons 20.9% 4.7% 18.4% 24.7% 25.0% 37.6% 4.1% 10.1%
Drug 43.6% 69.0% 46.3% 38.7% 33.7% 25.2% 68.7% 58.6%
Other 13.5% 7.4% 11.1% 15.4% 12.6% 11.2% 7.6% 13.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Alc/Drug Problem
Yes 75% 95% 89% 86% 86% 70% 96% 93%
No 25% 5% 11% 14% 15% 30% 5% 7%
100% 100% 100% 100% 100% 100% 100% 100%
1st serious drug Meth Meth Meth Meth Meth Heroin Meth Coc/Crack
2nd serious drug Alcohol Marijuana Alcohol Alcohol Alcohol Her/Barb Alcohol Alcohol
3rd serious drug Alcohol Alcohol Marijuana Alcohol Alcohol Her/Inhal Alcohol Alcohol
Most recent offense
Property 22.0% 18.9% 24.2% 21.2% 28.7% 26.0% 19.6% 18.1%
Against persons 20.9% 4.7% 18.4% 24.7% 25.0% 37.6% 4.1% 10.1%
Drug 43.6% 69.0% 46.3% 38.7% 33.7% 25.2% 68.7% 58.6%
Other 13.5% 7.4% 11.1% 15.4% 12.6% 11.2% 7.6% 13.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Alc/Drug Problem
Yes 75% 95% 89% 86% 86% 70% 96% 93%
No 25% 5% 11% 14% 15% 30% 5% 7%
100% 100% 100% 100% 100% 100% 100% 100%
1st serious drug Meth Meth Meth Meth Meth Heroin Meth Coc/Crack
2nd serious drug Alcohol Marijuana Alcohol Alcohol Alcohol Her/Barb Alcohol Alcohol
3rd serious drug Alcohol Alcohol Marijuana Alcohol Alcohol Her/Inhal Alcohol Alcohol
Most recent offense
Property 22.0% 18.9% 24.2% 21.2% 28.7% 26.0% 19.6% 18.1%
Against persons 20.9% 4.7% 18.4% 24.7% 25.0% 37.6% 4.1% 10.1%
Drug 43.6% 69.0% 46.3% 38.7% 33.7% 25.2% 68.7% 58.6%
Other 13.5% 7.4% 11.1% 15.4% 12.6% 11.2% 7.6% 13.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Descriptive Statistics
SATF
Gender Male Male Male Male Male Male Female Female
Classification Level I & II CA I II III IV CA I-IV
N 3054 1555 442 438 611 266 808 3355
Alc/Drug Problem
Yes 75% 95% 89% 86% 86% 70% 96% 93%
No 25% 5% 11% 14% 15% 30% 5% 7%
100% 100% 100% 100% 100% 100% 100% 100%
1st serious drug Meth Meth Meth Meth Meth Heroin Meth Coc/Crack
2nd serious drug Alcohol Marijuana Alcohol Alcohol Alcohol Her/Barb Alcohol Alcohol
3rd serious drug Alcohol Alcohol Marijuana Alcohol Alcohol Her/Inhal Alcohol Alcohol
Most recent offense
Property 22.0% 18.9% 24.2% 21.2% 28.7% 26.0% 19.6% 18.1%
Against persons 20.9% 4.7% 18.4% 24.7% 25.0% 37.6% 4.1% 10.1%
Drug 43.6% 69.0% 46.3% 38.7% 33.7% 25.2% 68.7% 58.6%
Other 13.5% 7.4% 11.1% 15.4% 12.6% 11.2% 7.6% 13.2%
100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%
1,000- and 2,000-bed Expansions
Treatment Participation StatisticsFemale Female
Male CAs Level I Level II Level III Level IV Felons CAs
SAP Treatment SAPs evaluated 3 2 1 1 1 5 2 Unique participants 2073 687 705 815 554 4313 1174 Treatment episodes 2219 694 705 817 568 4896 1366 Avg months/episode 9.6 7.9 11.2 10.5 8.9 6.1 8.1
No. of paroles 1301 271 268 310 202 2889 712 Paroles (% of tx episodes) 58.6% 39.0% 38.0% 37.9% 35.6% 59.0% 52.1% Aftercare participation rate 76.5% 47.2% 24.6% 38.4% 38.1% 32.8% 58.0%
Aftercare Unique participants 1019 133 71 122 79 978 433 Treatment epsiodes 2547 261 139 251 214 2045 894 Avg months/episode* 2.1 1.9 2.8 2.0 2.1 2.3 2.5
* Includes only closed treatment episodes
Implementation and Operational Issues
System Issues and Treatment Issues
CorrectionsSystem
TreatmentSystem
Society-focused
Punishment & Incarceration
Drug use is a crime
Person-focused
Treatment
Drug use is a disorder
Corrections and Treatment:Conflicting Philosophies
CorrectionsSystem
SuperordinateSystem
Corrections and Treatment:Organizational Reality
TreatmentSystem
SubordinateSystem
Bureaucratic
Resistant to change
Entrenched culture
Conformance
Criminal JusticeSystem
TreatmentSystem
“Society-focused”“Person-focused”
“Punishment & Incarceration”“Treatment”
“Drug use is a crime”“Drug use is a disease”
Corrections and Treatment:Who has the larger voice?
Collaboration and Communicationin a Supportive Organizational Culture
Culture ofDisclosure
CorrectionsSystem
TreatmentSystem
Open sharing ofsystem-, program-,and client-levelinformation in amanner that promotesunderstanding andtrust among peopleand organizationsfrom different partsof the system.
Ensures that the clientreceives effective,appropriate, andsufficient treatment.
Prendergast & Burdon (2002)
Commitment and support from correctional management (departmental and institutional).
Initiated at the top (director, wardens).
Communicated downward to line custody staff.
Toward a Supportive Organizational Culture of Disclosure
Sufficient Resources
$
Experienced and qualified treatment staff.
Recruit Train Retain
Adequate physical plantneeds.
Treatment space Office space for staff
Treatment Issues
Screening, assessment, and referral. Maximize the match between needs and treatment
received. Separate treatment for dually diagnosed and sex
offenders.
Incentives and rewards in treatment. Alleviate resentment and resistance. Increase motivation and involvement in treatment.
Coerced treatment. Efficacy has only been demonstrated in community-based
treatment settings.
SATF Program-Level Statistics
Disciplinary Actions, Drug Tests, and Aftercare Referrals
SATF Disciplinary Actions(SAP v. Non-SAP Facilities)
0
1
2
3
4
5
6
3rd Qtr 2000 4th Qtr 2000 1st Qtr 2001 2nd Qtr 2001
Ra
te p
er
10
0
Non-SAP SAP
Note: SAP facilities = A & B; Non-SAP facilities = F & G
0.2%
8.0%
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
Percent Positive
SATF CA Prison GP
Positive Drug Tests(SATF SAPs v. CA Prison GP)
Note: 24,269 drug tests conducted in SATF SAPs since February 1998.
0%
20%
40%
60%
80%
Cumulative 7/00-6/01
Aftercare Referrals at SATF
0%
20%
40%
60%
80%
Refused Self-referral
Denial NoProvider
Referral Rates Reasons for No Referral
Aftercare Referrals at SATF(Where are they going?)
0%
20%
40%
60%
80%
Resi-dential
Out-patient
SLE w/OP
Other
SATF Summary
Fewer disciplinary actions against SAP inmates.
Significantly lower prevalence of positive drug tests among SAP inmates.
Most inmates (82.7%) successfully parole from SAPs.
Over half of SAP parolees (53.9%) receive referrals to aftercare.
Caution: SATF is fully segregated. All other SAPs are not.
1,000- and 2,000-Bed12-Month RTC Data
Data collected on 8,498 Offenders
RTC Rates at 12 Months
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
SAP Drug(N=751)
SAP Sex(N=130)
SAP DuallyDiagnosed
(N=577)
SAP Total(N=1,458)
CDC Drug1998*
(N=23,985)
*Source: California Department of Corrections, Research Branch
32% 40%
Mean Days in Treatment
190
220
175
180
185
190
195
200
205
210
215
220
12-Month No RTC
Days Before RTC
p<.001
n=751 n=2827
Mean Days in Treatment
254 245
192
221
163
209
0
50
100
150
200
250
300
Low males* High males** Females
0-360 No RTC
n.s. p<.05 p<.001
* Low level males = Level I felons and Male CAs. ** High level males = Level II, III, and IV felons.
Special Populations
Sex Offenders Empirical support for a relationship between sexual deviancy and
alcohol abuse. Substance abuse is a primary trigger of sex offending behavior. Barriers include stigmatism, denial, untrained and inexperienced
treatment staff, institutional policies against disclosure,co-occurring disorders.
Mentally Ill (MI) High prevalence of substance abuse among MI. MI are significantly more likely to be incarcerated for a drug-related or
property offense. Within 12 months following release, MI parolees are twice as likely to
recidivate as non-MI parolees.
Others: HIV/AIDS Physically Disabled Geriatric
Summary & Recommendations
Change the culture.
Hire experienced treatment staff and take steps to minimize staff turnover.
Consider reducing program size.
Target volunteers.
Enhance motivation.
Implement valid and reliable screening and assessment methods and measures.
Offer incentives.
Mandate aftercare.
THE END